What is the treatment for pediatric bronchitis?

From the Guidelines

The treatment for pediatric bronchitis primarily focuses on symptom management and supportive care, with antibiotics only used in cases of confirmed bacterial infection, as recommended by 1 and 1. For acute bronchitis, which is usually viral, treatment includes:

• Ensuring adequate hydration
• Rest
• Using over-the-counter medications like acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours) to manage fever and discomfort
• A cool-mist humidifier to help loosen mucus and ease breathing
• Honey (5-10 mL) may be given to children over 1 year old to soothe cough, but should never be given to infants under 12 months due to botulism risk
• Cough suppressants are generally not recommended for children
• For bronchitis with wheezing or underlying asthma, bronchodilators like albuterol (2 puffs every 4-6 hours as needed) may be prescribed
• If symptoms persist beyond 2-3 weeks, worsen significantly, or if the child has difficulty breathing, high fever, or appears dehydrated, medical attention should be sought immediately, as suggested by 1 and 1.

It's essential to note that most cases of pediatric bronchitis resolve within 1-2 weeks with appropriate supportive care as the child's immune system fights off the infection. Some key points to consider:

• The use of antibiotics should be limited to cases with confirmed bacterial infection, as stated in 1
• The diagnosis of protracted bacterial bronchitis (PBB) can be made when the cough resolves within 2 weeks of treatment with antibiotics targeted to local antibiotic sensitivities, as recommended in 1
• Further investigations, such as flexible bronchoscopy and/or chest computed tomography, may be necessary when the wet cough persists after 4 weeks of appropriate antibiotics, as suggested in 1.

From the FDA Drug Label

Infections of the Lower Respiratory Tract:Amoxicillin for oral suspension is indicated in the treatment of infections due to susceptible (ONLY β-lactamase–negative) isolates of Streptococcusspp. (α-and β-hemolytic isolates only), S. pneumoniae, Staphylococcusspp., or H. influenzae.

The treatment for pediatric bronchitis may include amoxicillin for oral suspension, as it is indicated for the treatment of infections of the lower respiratory tract due to susceptible isolates of certain bacteria, such as Streptococcus species, Staphylococcus species, Haemophilus influenzae, and Streptococcus pneumoniae 2.

• Key points:
  • Amoxicillin should only be used to treat infections proven or strongly suspected to be caused by bacteria.
  • The development of drug-resistant bacteria should be considered when using amoxicillin.

From the Research

Treatment Overview

The treatment for pediatric bronchitis, also known as bronchiolitis, primarily focuses on supportive care, as most cases are mild and caused by viral infections 3. This approach includes:

• Assisted feeding and hydration
• Minimal handling
• Nasal suctioning
• Oxygen therapy

Pharmacological Interventions

The use of pharmacological therapies in bronchiolitis is still debated. Studies have shown that many pharmacological treatments, such as bronchodilators and corticosteroids, offer no significant benefit in this disease 3, 4, 5. However, nebulized hypertonic saline has been found to improve airway cleaning and respiratory function 3. Additionally, nebulized adrenaline has demonstrated short-term benefits 3.

Reduction of Unnecessary Medications

Efforts have been made to reduce the use of unnecessary medications in infants with bronchiolitis. A quality improvement initiative found that distributing an evidence-based management protocol and providing interactive sessions with online data collection and feedback significantly decreased the use of unnecessary treatments, including salbutamol, steroids, and antibiotics 4.

Management Practices

Management guidelines for bronchiolitis advocate for supportive care, and the use of bronchodilators and steroids is not recommended unless there are high-risk conditions or complications 5, 6. However, studies have shown that these medications are still frequently used, despite practice recommendations 5.

Antibiotic Use

Antibiotics are not recommended for bronchiolitis unless there is concern about complications such as secondary bacterial pneumonia or respiratory failure 6. A systematic review found minimal evidence to support the use of antibiotics for bronchiolitis, and research is needed to identify potential subgroups of patients who may benefit from antibiotic treatment 6.

Clinical Considerations

Pediatricians should be aware of the clinical course of bronchiolitis, including the peak severity of respiratory symptoms between days 3-7 and the importance of dehydration as a key sign for management 7. Bronchiolitis clinics and medical treatment should focus on supportive care and evidence-based guidelines to ensure optimal management of the disease 7.